ABSTRACT There are few studies of voluntary and involuntary turnover in the nursing home literature. Previous research in this area has focused mainly on the linear effects of individual and organizational characteristics on total turnover.
The purpose of this study was to examine both linear and nonlinear effects of organizational and environmental conditions on voluntary and involuntary nursing home staff turnover.
We analyzed both primary and secondary data on 854 nursing homes in six states. A negative binomial regression model was used to study both linear and curvilinear effects of organizational and environmental factors on voluntary and involuntary turnover among registered nurses, licensed practical nurses, and nurse aides.
Staffing levels and deficiency citations were the organizational characteristics most consistently linked with turnover among all nurse types. Links were also found between unemployment and type of location (urban or rural) and turnover, indicating that the economic environment is influential for retention.
The results of this study support the notion that policy makers need to consider both the organization and the environment when evaluating the nature of nursing home staff turnover. The findings also offer further evidence that the antecedents of voluntary and involuntary turnover are not necessarily the same.

[Show abstract][Hide abstract]ABSTRACT:
To explore the perspectives and priorities of nursing home residents, family members, and frontline nursing staff concerning a broad range of items representing common targets of culture change initiatives.
Qualitative study.
A Veterans Affairs Community Living Center and two community nursing homes in North Carolina.
Residents (n = 21), family members (n = 21), and direct-care nursing staff (n = 21) were recruited, with equal numbers in each group from each site.
Participants rated the importance of 62 items from the Centers for Medicare and Medicaid Services Artifacts of Culture Change instrument. Participants sorted cards reflecting each culture change artifact in two phases, identifying and ranking those of more and less importance to them to derive one distribution of preferences for each respondent. Q-sort analysis identified groups of respondents who prioritized similar items; qualitative analysis sought themes or explanations for the responses.
Wide variation in respondent preferences was observed. Some respondents viewed several items that others valued highly as unimportant or undesirable. Some items were not high priorities for any respondents. Four groups of respondents with similar preferences were identified: practical and independence-focused respondents, who prioritized ease of use of the physical environment; staff-focused respondents, who prioritized nursing staff retention and development; consistency and choice-focused respondents, who prioritized stable nurse staff-resident relationships and resident choice; and activity and community-focused respondents, who prioritized community gathering spaces and activities.
Resident, family, and staff priorities for culture change vary, and diverse priorities of stakeholders should be considered to inform culture change efforts on a local and national level.

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Studies of the causes and consequences of turnover at the group, unit, or organizational level of analysis have proliferated in recent years. Indicative of its importance, turnover rate research spans numerous academic disciplines and their respective journals. This broad interest is fueled by the considerable implications of turnover rates predicting broader measures of organizational effectiveness (productivity, customer outcomes, firm performance) as well as by the related perspective that collective turnover is an important outcome in its own right. The goal of this review is to critically examine and extract meaningful insights from research on the causes and consequences of group, unit, and organizational turnover. The review is organized around five major “considerations,” including (1) measurement and levels of analysis issues, (2) consequences, (3) curvilinear and interaction effects, (4) methodological and conceptual issues, and (5) antecedents. The review concludes with broad directions for future research.

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The authors conducted a meta-analysis of the relationship between turnover rates and organizational performance to (a) determine the magnitude of the relationship; (b) test organization-, context-, and methods-related moderators of the relationship; and (c) suggest future directions for the turnover literature on the basis of the findings. The results from 300 total correlations (N = 309,245) and 110 independent correlations (N = 120,066) show that the relationship between total turnover rates and organizational performance is significant and negative (ρ = -.15). In addition, the relationship is more negative for voluntary (ρ = -.15) and reduction-in-force turnover (ρ = -.17) than for involuntary turnover (ρ = -.01). Moreover, the meta-analytic correlation differs significantly across several organization- and context-related factors (e.g., types of employment system, dimensions of organizational performance, region, and entity size). Finally, in sample-level regressions, the strength of the turnover rates-organizational performance relationship significantly varies across different average levels of total and voluntary turnover rates, which suggests a potential curvilinear relationship. The authors outline the practical magnitude of the findings and discuss implications for future organizational-level turnover research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

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